What is Muscle Dysmorphia? Understanding the Struggle Beyond the Mirror

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Muscle dysmorphia, also known as "bigorexia" or reverse anorexia nervosa, is a psychological disorder characterized by an obsessive preoccupation with a perceived lack of muscle size and an exaggerated desire for muscularity. People with MD have a distorted perception of their body and believe that they are weak and undersized, even if they have an average or even muscular build.

Though it sounds like a physical ailment, muscle dysmorphia is a severe mental health condition. Understanding this condition is crucial for recognizing and addressing the psychological and mental aspects contributing to an individual's distress.

Definition and Overview​

Muscle dysmorphia is a relatively new concept in the field of mental health. It belongs to the classification of body dysmorphic disorders as a psychological condition characterized by an obsessive concern with one's perceived lack of muscle mass and an intense desire for increased muscularity.

Individuals with MD often engage in extreme behaviors to achieve their perceived ideal physique, such as excessive exercise, rigid dieting, and the use of performance-enhancing drugs.

It emerged in the 1990s as the fitness industry emphasized muscularity. The increasing cultural emphasis on a hyper-muscular male physique contributed to the manifestation of this disorder.

Media portrayals of the idealized male body during the early 90s, often exaggerated and unattainable, played a role in shaping societal standards. Images of heavily muscled men in advertising, movies, and fitness magazines may have contributed to the development of distorted body image perceptions.

Symptoms and Signs​

Psychological: Preoccupation with Muscularity​

Individuals grappling with muscle dysmorphia find themselves consumed by thoughts of inadequacy regarding their muscle size. This persistent preoccupation manifests as an overpowering desire for increased muscularity, dominating their mental landscape. Their perception of distorted body image can lead to a great deal of distress and anxiety.

Psychological: Obsessive Body Checking and Low Self-Esteem​

They frequently check their muscles in mirrors or compare their bodies to others. They may feel ashamed of their bodies and avoid social situations where their appearance may be on display.

Behavioral: Compulsive Exercise​

Muscle dysmorphia drives individuals into a relentless and intense workout regimen, surpassing recommended levels. The compulsion to exercise becomes all-encompassing, with an aversion to rest days stemming from the deep-seated fear of losing hard-earned muscle mass. They may lift weights, run, or engage in other forms of exercise. Still, they feel compelled to exercise even if injured or exhausted.

Behavioral: Rigid Dieting​

A hallmark characteristic of muscle dysmorphia is also the stringent adherence to a rigorous and often restrictive diet. These people may avoid certain foods altogether but also eat multiple small meals throughout the day to maximize muscle growth.

Behavioral: Use of PEDs​

In some cases, individuals with muscle dysmorphia use performance-enhancing drugs, such as anabolic steroids, to achieve their desired physique. This reckless pursuit of accelerated muscle growth blatantly disregards the potential health risks associated with such substances, marking a perilous crossing of boundaries.

Causes and Risk Factors​

Biological Factors​

There may be a genetic predisposition to developing muscle dysmorphia. Some studies have shown that individuals with a family history of body dysmorphic disorder (BDD) or obsessive-compulsive disorder (OCD) are at an increased risk of developing the condition.

Personal history like bullying or being teased about one's appearance may contribute to the development of muscle dysmorphia. Individuals who have faced criticism or rejection based on their physical appearance may develop a heightened sensitivity to body image issues.

Psychological Factors​

Certain personality traits, such as perfectionism and low self-esteem, may contribute to the development of muscle dysmorphia. Individuals with these traits may set unrealistic standards for their bodies.

Social Factors​

Individuals exposed to the bodybuilding culture may be more likely to develop muscle dysmorphia. This culture often emphasizes the importance of muscle size and definition, which can lead to unrealistic expectations and a distorted body image.

The Psychological Impact​

Anxiety and depression are common comorbidities in individuals with muscle dysmorphia. These conditions can exacerbate the preoccupation with body image and make it more challenging to cope with negative thoughts and feelings.

In some cases, muscle dysmorphia can lead to suicidal thoughts and behaviors. Individuals with this condition may feel like they cannot live with their distorted body image.

Muscle dysmorphia can also erode self-esteem. Individuals with this condition may feel ashamed of their bodies and may withdraw from social activities. They may also have a distorted self-perception, believing they are smaller or weaker than they are.

Physical Consequences​

Engaging in extreme bodybuilding practices and steroid use can have significant health risks and long-term physical consequences. Excessive and intense workouts without adequate rest can lead to overtraining syndrome. This condition may result in fatigue, decreased performance, and an increased risk of injuries.

Intense weightlifting and repetitive movements in bodybuilding can also lead to overuse injuries, affecting joints and muscles. Strains, sprains, and stress fractures are common among individuals engaged in extreme bodybuilding.

With the use of anabolic steroids, an individual may develop long-term illnesses such as cardiovascular diseases and liver damage. It may also disrupt the body's hormonal balance, leading to various issues, especially in men. Additionally, excessive use of steroids can lead to a reduction in bone density, increasing the risk of osteoporosis and fractures.

Influence of Gym Culture and Social Media​

Modern gym culture often emphasizes an idealized physique characterized by extreme muscularity, particularly for men. It often prioritizes aesthetics over overall health and well-being. This focus on physical appearance can lead to an unhealthy obsession with body image. Many gym environments also foster a sense of competition, pushing individuals to strive for higher levels of strength, endurance, and physical appearance.

Some aspects of gym culture may inadvertently contribute to body shaming, as individuals may feel judged based on appearance or performance. It can create a hostile and judgmental atmosphere, impacting individuals' mental well-being.

Like traditional media, social media platforms often showcase idealized body images, perpetuating standards that may be unrealistic for many individuals. Influencers and celebrities often present curated versions of their bodies, contributing to a distorted perception of what is considered normal or desirable.

Additionally, the prevalence of filters and photo-editing tools on social media platforms can further distort reality, creating an unattainable standard of perfection. Users may feel pressured to conform to these digitally altered images, impacting their self-image and body confidence.

Comparison with Other Disorders​

Body dysmorphic disorder (BDD) is a mental health condition characterized by a preoccupation with one or more perceived flaws in one's appearance. Compared with those with muscle dysmorphia, individuals with BDD may be concerned about their hair, skin, nose, weight, or any other part of their body.

Muscle dysmorphia is not an eating disorder, but it can share some symptoms with anorexia nervosa and bulimia nervosa. Individuals with anorexia nervosa may have a distorted body image and engage in excessive exercise to lose weight.

On the other hand, those with bulimia nervosa may purge or binge eat to control their weight. However, the primary focus in muscle dysmorphia is on muscularity, not weight or food control.

All three conditions share the core feature of a distorted body image, which often leads to low self-esteem. Individuals with these conditions have a significantly inaccurate perception of their bodies, believing they are fatter, thinner, or less muscular than they are. This distorted body image can cause significant distress and impairment in their daily lives.

Affected Demographics​

While muscle dysmorphia can affect individuals of any age or gender, it is most prevalent among males in late adolescence and young adulthood. Studies suggest that approximately 1% to 2% of men meet the diagnostic criteria for muscle dysmorphia, while the prevalence among women is significantly lower, estimated to be around 0.2% to 0.5%.

Men in sports, bodybuilding, fitness, and those involved in appearance-focused activities may be at a higher risk. These people may experience heightened pressure to conform to muscular ideals.

While less common, women with muscle dysmorphia may also experience a desire for increased muscularity. However, societal pressures for women often focus on thinness, contributing to body dissatisfaction and potentially influencing muscle dysmorphia.

Treatment and Recovery​

Cognitive-behavioral therapy (CBT) is the most widely used and effective form of psychotherapy for muscle dysmorphia. CBT focuses on identifying and modifying distorted thoughts and behaviors related to body image and self-perception. Through CBT, individuals can learn to challenge and reframe negative thoughts about their appearance.

In addition to psychotherapy, lifestyle changes can play a significant role in recovery. An individual can engage in regular physical activity, promoting overall fitness and well-being. However, avoiding excessive exercise that reinforces distorted body image perceptions is essential. Practicing relaxation techniques can also help manage stress and anxiety, which can exacerbate muscle dysmorphia symptoms.
Building a strong support system can also be invaluable in the recovery process. Connecting with others who share similar experiences can provide a sense of community, reducing feelings of isolation and promoting shared coping strategies. Additionally, professional support from a therapist can provide guidance and accountability throughout the recovery process.

Prevention Strategies​

Celebrate the natural body shape and size variations, emphasizing that beauty comes in many forms. Advocate for body positivity and challenge societal norms emphasizing a specific muscular or thin ideal. Raise awareness about the harmful impact of societal pressures on body image and muscularity.

Raising awareness and providing education about muscle dysmorphia is also crucial for prevention and early intervention. Dispelling common myths and stereotypes about mental illness can foster empathy and understanding.

Fostering a supportive environment in gyms and fitness settings can encourage individuals to discuss body image concerns and seek help, if needed, openly. Promoting open and honest conversations about mental health can help normalize discussions and encourage help-seeking behaviors.

Personal Stories and Recovery Narratives​

An anonymous user from Reddit shared that as a personal trainer, he grappled with muscle dysmorphia, constantly striving for an unattainable level of muscularity. This obsession led to physical exhaustion and social isolation. He underwent therapy to address distorted body image perceptions and engaged in activities that promoted a more balanced lifestyle.

A 25-year-old athlete also shared that in his early 20s, he was obsessed with achieving an idealized muscular physique. He started spending hours at the gym, lifting weights excessively, and restricting his diet to unhealthy eating habits. Muscle dysmorphia began to take a toll on his mental and emotional well-being. Through therapy, he began to understand how his distorted body image was affecting his life.

Expert Opinions​

According to Dr. Scott Griffiths of the University of Melbourne, individuals who seem to develop muscle dysmorphia should think of it as a reversal from anorexia. Steroid dependence may be prevalent, but an individual should remember that its prolonged use may have more profound and more extended consequences that may lead to death.

In a study published by the International OCD Foundation, individuals suffering from muscle dysmorphia are often risking injuries. They are desperate to achieve a more prominent and leaner body. Yet, they will not stop working out even when in pain. According to the researchers, if muscle dysmorphia becomes severe, it may sacrifice relationships, interests, and financial stability.

Resources for Help​

If you're struggling with muscle dysmorphia, here are some support groups that can help you cope with the condition:

• Body Dysmorphic Disorder Foundation: support@bddfoundation.org
• Aster Springs Muscle Dysmorphia Facility: (888) 741-0261, (855) 562-4305, (855) 841-6786
• International OCD Foundation (also treats body and muscle dysmorphia): eva@recoveryfrombdd.com
• The National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264)

Conclusion​

Muscle dysmorphia is a severe mental health condition that can have a significant impact on individuals' lives. It is an obsessive preoccupation with one's physique and a distorted perception of one's body image. This condition can lead to excessive exercise, restrictive dieting, and the use of anabolic steroids. Muscle dysmorphia can also cause social isolation, anxiety, and depression.

It is crucial to recognize and address muscle dysmorphia early on. With early intervention, individuals with this condition can receive the support and treatment they need to overcome their distorted body image perceptions and develop healthier relationships with their bodies.

Seeking professional help is a crucial step toward recovery. Mental health professionals, therapists, and support groups can provide tailored interventions and a supportive environment. Recognizing that recovery is a holistic journey encourages individuals to approach treatment with a well-rounded perspective.